When I was in the 4th grade, I had a book called Candy Stripers by Lee Wyndam. It consumed me. I read it over and over until the pages were worn and soft. I imagined what it would be like being a nurse. I related to Bonnie, the girl in the book who set out to be “just” a candy striper at her local hospital, and then found her calling as a nurse through the experience. I was entranced by what she did at the hospital, the people she helped, and the difference she made in her patients’ lives. That’s when I knew I wanted to be that to someone.
For all of us, there comes a time when we know. It may come from an experience of being treated, it may come from a book, but there is definitely a moment. It’s not so much a decision as a calling. I know this is true of the UAB nurse. Each of us has experienced a passion that comes upon us, the very passion that fuels what we do for the rest of our careers. In some ways I wonder if it isn’t the strength of that passion that defines the UAB nurse specifically. One thing I know as surely as I’m writing this: the successes of all of us are a direct result of the passions of each of us. So, that epiphany and that passion that becomes such an ingrained part of our lives – these are the ideas that frame this year’s annual report. It’s a sharing of our collective successes. It’s an unveiling of some of our individual passions.
Thank you for visiting our annual report. We look forward to your comments.
With warmest regards,
Velinda Block, DNP, RN, NEA-BC
Chief Nursing Officer
UAB Hospital
The NPC is made up of 39 representatives, including staff nurses, specialty nurses, educators, managers and directors. This cross-sectional representation has opened previously challenging channels of communication and enabled the Congress to enact real change.
This congressional model is a significant departure from where we had been. The NPC provides a clear and structured channel through which bedside nurses can submit issues. 
When an issue is received in Congress, a vote is held to decide whether or not a subgroup called a PACT (Professional Action Coordinating Team) will be created to take on the issue and resolve it. These multidisciplinary work groups led by staff nurses work to resolve clinical practice issues. In total, eighteen issues were formally presented to Congress in 2010 and, of those, thirteen PACTs were created, resulting in eight clinical practice changes.
Instead of being passive participants, relying on someone else for a final decision, our nurses can proactively take matters through an active channel to produce evidence-based solutions resulting in better patient care. Having a Congress means stepping up and owning care-related issues. By recognizing care issues and taking ownership we are able to hold ourselves accountable for the care we provide our patients. The NPC represents empowerment and accountability, and it has been embraced wholeheartedly.
Once a PACT is created, the team works together to dissect issues and develop solutions. Collaborating across disciplines, these PACTs work together to change nursing practice throughout the organization. Most issues affect multiple players, not just nurses. The PACTs are effective because they take into consideration the concerns of all stakeholders. While every effort is made to improve a situation for all involved, the patient remains the primary focus.
In our first year, we have already witnessed successful collaborations between multiple disciplines, resulting in credible change in nursing practice throughout our organization. In 2010 Nursing Practice Congress made eight clinical practice changes including:
• Implemented a medication/time-out zone
• Developed a Hand-off Communication Process
• Created a Difficult Venous Access Algorithm
• Converted from disposable blood pressure cuffs to reusable blood pressure cuffs
• Created a working list to improve workflow with regard to lab specimen collection
As with any new undertaking, there is initially a steep learning curve, so our journey has not been without challenges. Our congressional representatives continue to grow professionally, gaining a better understanding of their role as a congressional member. Nurse managers and advanced nursing coordinators are collaborating with staff to optimize care hospital-wide . Other departments are also gaining respect for the NPC and actively seek opportunities to partner with nursing. The first year has been positive, productive and rewarding.
Elections for new representatives will take place in 2011 and based on how well received Congress has been this year, we anticipate that many more nurses will be eager to participate. The efforts and dedication of this first Congress has set a high standard for future accomplishments.
Patient and family-centered care is an approach to the planning, delivery, and evaluation of healthcare, grounded in mutually beneficial relationships among healthcare providers, patients, and families. Patient and family-centered care improves the quality and effectiveness of communication; it is proactive rather than reactive. It recognizes and respects the profound influence families have on patients’ health and well-being and views patients and their family members as allies in quality healthcare.
Adopting the patient and family-centered care approach means that its values shape policies, programs, facility design, and staff day-to-day interactions. It leads to better health outcomes, wiser allocation of resources, and greater patient and family satisfaction.
The process of incorporating patient and family-centered care is far-reaching and ongoing. And, like all collaborations that seek to build strong relationships, it relies on constant and honest communication. Some results are already being implemented. One excellent example is in longer ICU visiting hours. Studies have shown that allowing family members more time with critical patients actually speeds the healing process. While a few of our Intensive Care Units (ICU) had family friendly visiting hours, some did not. For those ICU’s limited to 2 hours of visiting, we have expanded ICU visiting hours from two to four. In 2011, that time will be increased to a minimum of eight hours each day by the end of February, and by January of 2012, at least 20 visiting hours will be available in all ICUs.
At the same time nursing adopted patient and family-centered care, the CEO of UAB Health System, Dr. Will Ferniany, attended a national presentation on patient and family-centered care. Upon his return, Dr. Ferniany asked who in our organization was most passionate about patient and family-centered care. While there are many, nurses and other staff members who share this passion, Shannon Graham, DNP, RN, AOCN became the lead for organizing a UAB Health System wide symposium, introducing patient and family-centered care. The half day symposium featured speakers from across the nation that have instituted patient and family-centered care at their respective facilities. Attendees at the symposium participated in focus groups and breakout sessions to discuss critical issues and solicit ideas for improvement.
The symposium resulted in a patient and family-centered care team comprised of physicians, nurses, pharmacists, dieticians, patients, members of patients’ families, a guest services representative and anyone else involved in the patient/family experience. Co-chaired by Velinda Block, DNP, RN, NEA-BC, Chief Nursing Officer, the team is currently examining each aspect of the patient and family experience and exploring avenues to improve our care delivery.
We will continue to look for ways to actively include family members in care and decision-making. Our staff will become even more adept at incorporating patient and family knowledge, values, beliefs and cultural backgrounds into care delivery. We believe that, as a result of including the family more holistically, many problems will be prevented and others will be handled before they grow. Patient outcomes and satisfaction will improve. The possibility of miscommunication, dissatisfaction and even medical errors will be further diminished. In short, the quality of care will increase.
As part of the process, our nurses and physicians spent time in the facility before it opened, taking part in scavenger hunts and simply exploring their new future home. By the time moving day arrived, they knew their way around the building and were familiar with its features, which made the transition of patient care seamless.
The move itself was actually ahead of schedule. Thanks to meticulous pre-planning and preparation, which included a considerable amount of nurse education, we conducted the entire move – patients and all – in just eight hours.
As one might imagine, mothers and fathers experienced trepidation at relocating from one building to another during a time in their lives that was already eventful. But, those fears were assuaged by the expeditious move and a healthcare team that made sure there were no lapses in patient care.
Our nurses also expressed apprehension about some of the features of the new facility and how the transition of moving patients from the old facility to the new one would impact patient care. In particular, the decision to employ a private room design in both the Regional Newborn Intensive Care Unit (RNICU) and Continuing Care Nursery (CCN) was a concern. Consultants from other hospitals that had used private rooms for high-risk infants were brought in to answer questions about how the transition impacted care. Now in use, the nurses have witnessed and experienced the benefits for patients, families, and staff. Additionally, the design of the rooms has enhanced our ability to provide family centered care as families are able to stay round-the-clock to be close to their infants.
The Women & Infants Center also afforded us the opportunity to extend our connections to the community. We had always had strong community initiatives, especially with the March of Dimes, with which we have worked for many years. Now, however, our facility enables us to offer community education classes at night, providing a light dinner, a speaker, and free parking. Our topics include Maturing Women, Childbearing Years, and other subjects relevant to the community at large. And this past holiday season included a tree lighting ceremony, an opportunity for siblings to visit with Santa, and a performance by a community high school choir.
While our nurses exhibit great pride in being able to offer one of the finest facilities of its kind along with incredible amenities to their patients and families, perhaps the truest testament has been the sudden increase in the number of patients from a very specific group that are now choosing to use the facility for their own care – UAB employees.
And, while the goal is always to achieve better scores, the real brass ring is in patient care. Fact is, better scores mean better outcomes.
Last year, the nursing leadership at UAB determined that in order to enhance our focus on patient care outcomes, we needed to restructure the Nursing Quality Council under the umbrella of the Center for Nursing Excellence. 
So in a thorough and deliberate fashion, a work team set about developing a new framework that started with a planning retreat in May of 2010. From the retreat, they emerged with a redesigned structure. The new Nursing Quality Council includes staff nurses, nurse leaders, and others who both expressed interest and had the ability to make meaningful contributions.
The purpose of the Nursing Quality Council is to facilitate a comprehensive approach for the identification, measurement and evaluation of key structures, indicators, processes, and outcomes related to the delivery of professional nursing care.
In a short time, they have established a pattern of successful accomplishment. In the area of Nurse Sensitive Indicators they identified an opportunity to standardize the way data was being gathered across units. There had been inconsistency and incompleteness, so they created a comprehensive approach wherein all relevant units would collect the same type of data and report it in the same way. Doing so broadened participation and allowed "apple-to-apple" comparisons of performance.
For 2011, the Nursing Quality Council has formed teams that will look at the data to determine targeted improvement areas. The data will be published on unit level dashboards, and teams of staff members in each unit will work collectively to interpret the information and develop specific action plans. Progress will be shared throughout the department via staff meetings and "Quality Bulletin Boards."
Open and active communication between Highlands and University Hospital was our first and most critical focus as we began blending our standards to create consistency across the two campuses (the Highlands facility is a half-mile from the UAB Hospital campus). The Highlands staff met the transition head on and with a can-do attitude, remaining optimistic, diligent, and never letting the quality of care falter while their entire workplace underwent tremendous change. Highlands' entire building was wired to accommodate wireless, a new phone system and Electronic Medical Record system, as well as Physician Order Entry, and Electronic Medication Administration Record (EMAR) for Impact. 
With the March 2011 launch of electronic clinical documentation, the conversion from paper medical records to electronic records will be complete.
We restructured some services in order to take advantage of all of our facilities and to best utilize their combined resources. The Pain Clinic and Sleep Center were moved to the Highlands campus, and we opened a new endoscopy suite for procedures that had previously been handled in the main operating room. In May, we will begin a two-year, multi-million-dollar renovation of our operating rooms there.
The overall number of physicians practicing at Highlands has increased to meet the growing demands, and leaders from both facilities have combined forces to ensure access to important services. Opportunities for enhanced education, clinical advancement, and involvement in the shared governance process are proving to be exciting for the Highlands nursing staff.
"The whole idea of evidence-based nursing practice and research is to infiltrate the culture and catalyze a culture change. 
It's about education," says Connie. Her mission is to get every nurse involved in evidence based practice and research to continually improve nursing practice. Yes, it's a massive undertaking. But it is one that is keeping UAB ahead of the curve when it comes to best practices and quality care.
The EBP Tiered Mentorship program is a competitive program in which applicants submit an essay that answers the question: "What does evidence-based practice mean to me as a nurse?" The applications are blindly graded and the top essays are chosen to participate in the program.
EBNP at UAB aims to make clinical decisions by integrating the best available evidence, coupled with clinical expertise and patient values. It represents the nexus between scholarly pursuit and applied practice. And it is a skill that is absolutely vital to providing excellent care.
In addition, Dr. Connie White-Williams from the Center for Nursing Excellence provides a number of workshops throughout the year that help nurses pursue EBNP and research endeavors by making it part of their practice:
From a greater perspective, it begins with an inquiry: "Why? Why are we doing it this way? And how can we be sure we are doing it the best way?" The EBNP process seeks the best possible answer based on available evidence.
Defining evidence is no small part of the challenge. In medicine, there is an explosion of literature. Often, it would be more than a full-time pursuit to read the plethora of papers produced germane to a given area. The skills of EBNP allow nurses to focus and be discerning in finding the best answers to the questions that arise both in daily practice and in specific inquiries.
The five staff nurses admitted to the program last year are now actively working on their projects. Beginning in June 2011, another group of nurses will be selected for the EBP Tiered Mentorship Program and the propagation of EBNP will continue.
On-boarding: A New Approach to Nursing Orientation
Whether new hires are fresh graduates or seasoned veterans, our goal is to help them be fully functioning employees as soon as possible.
The way we had been doing things - eight hours a day of lectures and PowerPoint presentations for two weeks - wasn't resulting in developing a high percentage of professional knowledge retention. So we've developed a process of blended days called "on-boarding." On-boarding immerses new nurses in the culture of our facility from the beginning, focusing on leadership, professional practice, professional development, patient safety, evidence-based practice, and quality outcomes.
Instead of lectures during the first week, new hires participate in unit-based activities with moderate classroom time. They learn our codes and receive hands-on time to explore our information management systems. They spend each day focused on topics such as how the medication administration process works, what the safety guidelines are, and how to recognize often subtle signs that call for lightning-fast responses. Then they meet at the end of each day to be debriefed and discuss what they learned.
Following blended days, nurses have unit-specific schedules. Evaluation and skills validation occur at incremental points throughout this first year. At 18 months, there are still advanced workshops to elevate the new hire to the next level.
On-boarding allows the whole team to be involved. Individuals serve as "buddies" for our new folks, answering questions, making introductions, and forming a bond. On-boarding began in 2011, and the results show that both new and existing employees are more engaged.
Setting the Standards: Lippincott Nursing Skills & Procedures
In the past, UAB maintained its own specific set of standards. They were updated every three years on an internal website, a task that was tedious and time consuming in a format that wasn't user-friendly. We knew there had to be a better way, so we undertook a process to find just that.
A search team consulted with other academic hospitals, researched available electronic standards, narrowed the choices to two, and tried them on for fit. Both companies sent representatives, made the requisite presentations, and provided access to demo systems. Nurses explored both systems and provided feedback. The final choice was Lippincott Nursing Skills & Procedures, a system that links with HealthStream, UAB's online education program.
Teams have now been assigned to review both Lippincott and UAB standards to ensure the new system is as up-to-date as possible, and that the integration is complete. When it launches, Lippincott Nursing Skills & Procedures will provide a system with more than 1,000 standards that is easier to navigate, reviewed annually, and eliminates the need for UAB to perform its own three-year updates. In 2011, we will see the completion of the review and a launch later in the year.
Doing a 360: Performance Appraisals
Another exciting 2011 change will be the transition from a paper system of performance appraisals to an online system – a move that will eliminate an astonishing amount of paperwork, while still providing all the inputs to assess performance and guide professional growth.
The appraisal system rates employees in two areas: Core Values (50%) and Technical Skills (50%). The new system will notify employees of the upcoming performance appraisal and ask them to complete a self-evaluation.
Peers will also be part of this new process by using the 360 Tool that focuses on each staff member's abilities in terms of patient interaction, technical skill, documentation accuracy, and adherence to professional standards. All forms will be completed online, and then supervisors and employees will meet face-to-face to review.
An introduction to the new system and training will begin this spring, and by September, evaluations using it will be underway.
